By Keith R. Boyer, D.D.S.
Endodontic education changed significantly in the past year due to the COVID-19 pandemic. The emergence of state and local mandates restricting in-person education, along with guidance to limit dental patient visits to emergencies only,1 forced dental schools to quickly modify their curriculums. While some programs closed completely for varying periods of time, others were able to continue teaching by pivoting to a virtual environment almost overnight. These technological adaptations of didactic, preclinical, and clinical education allowed dental students and endodontic residents to continue their training despite the circumstances.
Moving didactic class sessions online presented as the logical choice for faculty to provide remote learning, while maintaining interaction with students. Most students are considered ‘digital natives’; according to a survey at one university, 72% of students had completed at least one online course prior to dental school.2 As such, the transition to virtual distance learning proved relatively seamless.3 There was an increased utilization of ‘flipped classrooms’, in which students prepare for class by reading assignments or watching videos ahead of time, then attend class sessions ready to engage with the material with case studies, discussions, or other interactive exercises rather than traditional lecture.4 In addition, remote proctoring software has enabled students to securely take exams from their own homes. In endodontic residency programs, case presentations and literature reviews for residents also moved online. By increasing the number and depth of these assignments to make better use of the time away from clinic, residents saw more session availability after returning to normal patient care. Additionally, multiple post-graduate endo programs were able to benefit from renowned guest lecturers ‘Zooming in’ from around the country to speak without travel considerations or space limitations.
Since endodontics is highly dependent on practical and tactile learning, educators offered creative solutions to prolonged closures of preclinical simulation labs. At some schools, students were given equipment to take home to practice their hand-skills. A substantial portion of the endodontic module at one dental school was accomplished with clear plastic teeth in the students’ own homes, with faculty giving live feedback via video conferencing platforms [Figure 1].5 Other programs postponed preclinical courses until restrictions were lifted and students were able to return to lab with social distancing measures. Alternative technological solutions also included virtual reality haptic feedback simulators [Figure 2] and 3D models with augmented reality, such as the 3D Tooth Atlas (eHumanTM).4 Though unconventional and often time-compressed for most students, the modified preclinical experiences resulted in enhanced learning due to better visualization of anatomy and improved student-to-faculty ratios.
Of all aspects of dental school curriculum, clinical education and practice underwent the most dramatic changes, especially as the utilization of teledentistry became essential for safe clinical practice. Some facilities were not seeing any patients in person, and those that were, limited treatment to emergencies only. Dental students, endo residents, and faculty triaged patients’ concerns over the phone and video conferencing to determine whether they had to be seen at the dental clinic, could be managed by prescriptions, or needed referral to the emergency room. Telehealth also became a reliable tool to screen patients for COVID symptoms prior to appointments and to record patient history before in-person consultations. At some institutions, students and residents were restricted from coming onto campus, and faculty were often the sole providers for the patients who received treatment. These emergency dental services provided great relief to the overwhelmed hospitals. At one institution’s emergency clinic, 86% of the patients seen and treated at the school would have otherwise required an emergency room visit.6
In addition to the teledentistry solutions, many adaptations are being implemented to limit the possibility of disease exposure: Fewer patients are seen at one time, and the flow through clinics is modified to reduce cross-traffic. Smart phones and webcams let patient coordinators communicate with providers and patients and accept payments without direct contact. These may seem like hurdles that reduce the overall efficiency of clinical care, but the exact opposite has proven true. Despite shorter appointment times and as they realize the value and importance of their clinical sessions, students and residents make strides to complete cases and care for their patients.7
Of the students who were scheduled to graduate in 2020, some had not completed their required clinical exams or experiences prior to school closures. Some students stayed past the graduation date to demonstrate competency, while others were able to graduate with the rest of their class because faculty provided alternative assessments. Objective Structured Clinical Examinations (OSCEs)—written or oral exams based on cases which evaluate diagnostic, critical thinking, and clinical reasoning skills—were given remotely when completion of live patient exams were impossible due to restrictions posed by the local health departments.8,9 Additionally, with the use of dashboard software, universities could qualitatively track student progress and growth longitudinally, instead of with a ‘single instance’ exam.10 Current technology allowed a shift from the traditional model of clinical requirements to assure that graduates have attained the knowledge and skills to begin practice.
Lastly, the pandemic has not deterred people from seeking to enter predoctoral or residency dental programs. Anecdotally, applications to dental schools and endodontic residency programs increased in 2020 to record levels. This may be due to factors such as prospective students having more time to complete applications, virtual interviews reducing travel costs, and many post-graduate programs waiving or not requiring the ADAT exam. During times of uncertainty, being in school has the potential to act as a shelter from the economic circumstances. Dentistry, and more specifically the practice of endodontics, is still viewed as a desirable and essential profession.
With newly found efficiencies and capabilities, many technological advances are here to stay. Remote learning will continue well into this year and most likely beyond. The pandemic has removed typical financial, time, and travel considerations, which has opened doors for applicants to interview remotely, speakers able to present from anywhere in the world, and conferences to take place from the comfort of one’s own home.10 The ramifications of the pandemic were and remain widely felt, particularly in dentistry, but due to engaged faculty, motivated scholars, and understanding patients, students and residents still receive the education they need to graduate as competent dentists and endodontists, with the added benefit of learning resiliency to face previously unimaginable situations. The future of the endodontics specialty is still very bright.
The author would like to acknowledge and thank Dr. Alan Gluskin, Dr. Bekir Karabucak, and Dr. Jamie Parado for their contributions to this article and for their lasting mentorship.
- ADA calls upon dentists to postpone elective procedures. ADA 2020. Available at: https://www.ada.org/en/press-room/news-releases/2020-archives/march/ada-calls-upon-dentists-to-postpone-elective-procedures. Accessed February 21, 2021.
- Hung M, Licari FW, Hon ES, et al. In an era of uncertainty: Impact of COVID-19 on dental education. J Dent Educ. 2021;85:148-156. https://doi.org/10.1002/jdd.12404
- Meyer H. Sharing results. AAE Available at: https://www.aae.org/specialty/2020/07/29/sharing-results/. Accessed February 21, 2021.
- Elangovan S, Mahrous A, Marchini L. Disruptions during a pandemic: Gaps identified and lessons learned. J Dent Educ. 2020;84:1270-1274. https://doi.org/10.1002/jdd.12236
- Boyer KR, Chui BS, Ywom J, Farah-Franco SM. Teaching preclinical endodontics virtually. J Dent Educ. 2020;1-3. https://doi.org/10.1002/jdd.12238
- Langella J, Magnuson B, Finkelman MD, Amato R, Clinical Response to COVID-19 and Utilization of an Emergency Dental Clinic in an Academic Institution. Journal of Endodontics (2021), doi: https://doi.org/10.1016/j.joen.2020.11.025.
- Guinn T. From the heart: COVID-19 column. AAE Available at: https://www.aae.org/specialty/2020/11/24/from-the-heart-covid-19-column/. Accessed February 21, 2021.
- Alon E, Amato R. Evaluation of endodontic competency in the COVID-19 era: Problem, solution and results. J Dent Educ. 2020;1-4. https://doi.org/10.1002/jdd.12237
- Martinho FC, Griffin IL. OSCE online teaching in predoctoral endodontics. J Dent Educ. 2020;1-2. https://doi.org/10.1002/jdd.12418
- Saeed SG, Bain J, Khoo E, Siqueira WL. COVID-19: Finding silver linings for dental education. J Dent Educ. 2020;84:1060-1063.